Healthcare Provider Details

I. General information

NPI: 1174512545
Provider Name (Legal Business Name): G.KNIGHT INC DBA SHOALS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 E AVALON AVE
TUSCUMBIA AL
35674-1773
US

IV. Provider business mailing address

1404 E AVALON AVE
TUSCUMBIA AL
35674-1773
US

V. Phone/Fax

Practice location:
  • Phone: 256-389-9800
  • Fax: 256-389-1594
Mailing address:
  • Phone: 256-389-9800
  • Fax: 256-389-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number112554
License Number StateAL

VIII. Authorized Official

Name: DR. GERALD V KNIGHT
Title or Position: OWNER
Credential: PHARM. D., R. PH.
Phone: 256-389-9800